Der Unfallchirurg
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Case Reports
[The simultaneous distally based sural flap. A therapeutic option for coverage of both heels].
Exposed bradytrophic tissue in regions with high mechanical loading is an indication for defect coverage with (myo-, adipo-) fasciocutaneous flaps. In this case, distally based sural flaps were used for bilateral coverage of defects in weight-bearing areas of feet after fourth-degree frostbite. ⋯ Among its advantages in comparison to free microvascular flaps, the locally based fasciocutaneous flap can be harvested with less donor site morbidity after elevation and does not require secondary debulking. It has been shown that the reduced stability at the border zone between flap and mesh graft has an adverse effect.
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Intra-articular injuries are common after dislocation and fracture of the hip joint and can be addressed using hip arthroscopy. The most common indications for this procedure are loose bodies, labral tears and chondral defects. In addition, preexisting femoroacetabular impingement can be addressed at the time of surgery. ⋯ In addition loose bodies were removed in the first patient and a femoral osteoplasty was performed in the second patient. Hip arthroscopy has proven to be a safe and effective surgical technique for treating specific post-traumatic lesions and preexisting femoroacetabular impingement. The current case reports provide an overview of the indication for hip arthroscopy following traumatic injuries to the hip.
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Soft-tissue emphysema following surgical procedures needs prompt and accurate diagnosis in order not to miss severe infections, such as clostridial myonecrosis and necrotizing fasciitis. We report the case of a 32-year-old patient who developed massive crepitation of the right leg and thoracic wall after knee arthroscopy had been performed a few days earlier. He was readmitted under suspicion of gas gangrene. ⋯ An intercompartment emphysema could be confirmed intraoperatively. The postoperative course was uneventful. The main differential diagnoses of benign soft Tissue emphysema are summarized and treatment options are recommended.
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Operating rooms are the central unit in the hospital network in trauma centers. In this area, high costs but also high revenues are generated. Modern operating theater concepts as an integrated model have been offered by different companies since the early 2000s. ⋯ Besides the described effects further savings might be achieved through the effective use of voice control and the benefit of the sterile handle on the navigation camera, since waiting times for an additional nurse are minimized. The time of the procedure of intraoperative imaging is also reduced due to the ceiling-mounted concept, as the C-arm can be moved freely in the operating theater without hindering cables. By these measures and ensuing improved efficiency, the initial high costs for the implementation of the system may be cushioned over time.
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The intraoperative application of augmented reality (AR) has so far mainly taken place in the field of endoscopy. Here, the camera image of the endoscope was augmented by computer graphics derived mostly from preoperative imaging. Due to the complex setup and operation of the devices, they have not yet become part of routine clinical practice. ⋯ It combines its video live stream geometrically correct with the acquired X-ray. The clinical application of the device in 43 cases showed the strengths of the device in positioning for X-ray acquisition, incision placement, K-wire placement, and instrument guidance. With its new function and the easy integration into the OR workflow of any procedure that requires X-ray imaging, the CamC has the potential to become the first widely used AR technology for orthopedic and trauma surgery.